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Cited by 51

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Heavyweight mesh is superior to lightweight mesh in laparo-endoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis of randomized controlled trials.

Bakker, Wouter J., Aufenacker, Theo J., Boschman, Julitta S., Burgmans, Josephina P. J.·2021·Annals of Surgery
DOI 10.1097/sla.0000000000003831
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Abstract

Objective: This meta-analysis and trial sequential analysis aims to provide an update on the available randomized controlled trials (RCTs) and recommendations on using lightweight mesh (LWM) or heavyweight mesh (HWM) in laparo-endoscopic inguinal hernia repair. Background: LWM might reduce chronic pain through improved mesh flexibility and less fibrosis formation. However, in laparo-endoscopic repair chronic pain is already rare and LWM raise concerns of higher recurrence rates. Methods: A literature search was conducted in May 2019 in MEDLINE, Embase, and the Cochrane library for RCTs that compared lightweight (≤50 g/m 2) and heavyweight (>70 g/m 2) mesh in patients undergoing laparo-endoscopic surgery for uncomplicated inguinal hernias. Outcomes were recurrences, chronic pain, and foreign-body sensation. The level of evidence was assessed using GRADE. Risk ratios (RR) and 95% confidence intervals (CI) were calculated by random effect meta-analyses. Trial-sequential-analyses were subsequently performed. Results: Twelve RCTs, encompassing 2909 patients (LWM 1490 vs HWM 1419), were included. The follow-up range was 3 to 60 months. Using LWM increased the recurrence risk (LWM 32/1571, HWM 13/1508; RR 2.21; CI 1.14–4.31), especially in nonfixated mesh direct repairs (LWM 13/180, HWM 1/171; RR 7.27; CI 1.33–39.73) and/or large hernia defects. No difference was determined regarding any pain (LWM 123/1362, HWM 127/1277; RR 0.79; CI 0.52–1.20), severe pain (LWM 3/1226, HWM 9/1079; RR 0.38; CI 0.11–1.35), and foreign-body sensation (LWM 100/1074, HWM 103/913; RR 0.94; CI 0.73–1.20). Conclusion: HWM should be used in laparo-endoscopic repairs of direct or large inguinal hernias to reduce recurrence rates. LWM provide no benefit in indirect hernias.

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Metadata

Authors
Bakker, W. J., Aufenacker, T. J., Boschman, J. S., & Burgmans, J. P. J.
Affiliations
  • Hernia Clinic, Department of Surgery, Diakonessenhuis, Zeist, Utrecht, the Netherlands
  • Department of Surgery, Rijnstate, Arnhem, the Netherlands
  • Dutch Knowledge Institute of Medical Specialists, Utrecht, the Netherlands.
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-03-27
Volume
273
Issue
5
Pages
890-899
ISSN
  • 0003-4932
  • 1528-1140
DOI
10.1097/sla.0000000000003831
Cited by
51
References
1
Language
en

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CoChat. (2026). Citation check: Heavyweight mesh is superior to lightweight mesh in laparo-endoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis of randomized controlled trials. https://app.cochat.ai/papers/10.1097/sla.0000000000003831
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Bakker, W. J., Aufenacker, T. J., Boschman, J. S., & Burgmans, J. P. J. (2021). Heavyweight mesh is superior to lightweight mesh in laparo-endoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis of randomized controlled trials. Annals of Surgery. https://doi.org/10.1097/sla.0000000000003831

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